Are you having trouble figuring out how the intense pain that runs down the back of your leg began? Perhaps it was a long day working in the yard or the extra mile you added to your walk. It could also be that you sat too long in the theater or watching the ball game. If you have pain in the buttock that travels to the knee or ankle, you might have Piriformis Syndrome.
PS can be excruciatingly painful. Pain typically begins in the back of the hip around the mid-buttock and travels down the back of the leg into the knee. In severe cases it will reach the ankle. One of the most common complaints is that you are unable to bear weight on the affected limb because "you don't trust it."
Classically, PS worsens as the day passes. Morning stiffness and discomfort transform into a throbbing, toothache-like pain by late afternoon. Unfortunately, most patients are unable to find a position of comfort and must deal with their symptoms until falling asleep for the night - only to look forward to the cycle beginning again in the morning.
As the biggest nerve in the body, the sciatic nerve is responsible for the sensation in the back of your leg from your hip to your ankle. Imagine what it would feel like if you put that nerve in a vice and tightened it down. The piriformis is a thick, tough muscle with two distinct heads that are in close contact with the sciatic nerve. In 25 percent of the population, the sciatic nerve passes between the two parts of the muscle and is in serious jeopardy of being pinched if the muscle gets tight. In the other 75 percent, the nerve passes underneath the two heads exposing it to forceful compression against the ball of the hip joint.
People that develop tightness in the hip joint are most susceptible to acquiring PS. Although there are a number of different origins, PS is strongly linked to advanced age and a lack of stretching.
Most patients who suffer from the disorder are over 50 and lead normal, active lives but do not take appropriate steps to stay limber. They ignore their symptoms and try to "work through it anyway" hoping it will just "go away."
PS may also acquired by sitting on a thick wallet. A wallet in a back pocket increases the compressive force on the sciatic nerve and piriformis muscle by 400 percent. For some patients, a quick solution is switching the wallet to the front pocket, although this does not work for all people.
Almost all cases of PS are highly correlated with poor hip mobility and respond excellently to mobilization and stretching in a therapeutic environment. Anyone wondering if their hip is causing them pain, follow the instructions for the two photos to see if it provokes your symptoms.
PS does not have a natural lifespan and will most likely stay until treated. Once it has settled in it can be a difficult tenant to evict. Also, PS will increase stiffness in the hip and perpetuate the problem, so don't wait too long to be seen.
Cases that have come on within the last six to 12 weeks can usually be resolved inside of a month, depending on the severity of the symptoms. Amazingly, most people limp for three months or more before consulting their doctor about treatment, raising the length of time it takes to rehab their hip.
The only way to eliminate and keep Piriformis Syndrome at bay is through heavy, frequent doses of stretching and mobilization. Consult with a physical therapist skilled in mobilization — your hip won't regret it.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly.¬ Questions may be submitted to On the Mend, c/o Salem News, 32 Dunham Road, Beverly, MA 01915 or e-mail firstname.lastname@example.org.